Oral health promotion initiated during pregnancy successful in reducing early childhood caries

Abstract

Design: This was a randomised controlled trial using Zelen's design.

Intervention: Women in the test group received three rounds of printed information supplied in the form of anticipatory guidance. The first round of information was provided at enrolment. The second and the third rounds of information were mailed to the mother's home address when their child reached 6 and 12 months of age. The topics covered in each round offered mothers information and support relevant to their own and the child's oral development across the subsequent 6 months period. In addition, the first round of literature included information for expectant mothers related to oral health changes during pregnancy, with emphasis on oral hygiene during pregnancy and proper nutrition. Other topics covered in this round were the importance of primary teeth, the use of pacifiers and the sleeping patterns of the child. The second and third rounds of information were concerned with the eruption of teeth, oral hygiene and nutrition. The oral health promotion material was supplemented with the existing nutritional recommendations. Half of the mothers in the test group were randomly selected to test the impact of a structured telephone consultation as an additional mode of contact. The structured telephone consultation was conducted as a scripted interview. Four questionnaires were also conducted (a maternal oral health survey, refusal to participate, child's oral health survey, and evaluation of oral health intervention).

Outcome measures: The main outcome was severe early childhood caries (S-ECC). A case of S-ECC was defined when one or more upper incisor teeth labial surfaces were carious, either noncavitated or cavitated. Diagnosis was based on visual criteria only.

Results: Out of 649 women enrolled in the programme (test group, 327l control group, 322), 441 had their child examined at followup. The incidence of S-ECC in the test group was 1.7% and in the control group was 9.6% (P < 0.001).

Conclusions: An oral health promotion programme based on repeated rounds of anticipatory guidance initiated during the mother's pregnancy was successful in reducing the incidence of S-ECC in these very young children.